So the plenary sessions are where what the selection committees thought were the most important research abstracts submitted are presented. The first plenary session hit the highlights in RA research.
I’m not going to go too nuts and describe everything presented in detail. The first two abstracts presented were heavy duty basic research items, and I must admit I didn’t follow them completely. The first abstract’s gist was that the authors found a new gene that appeared to be associated with RA in some cases. I always view these studies with skepticism because they are often not confirmed. The second abstract described a new mediator of inflammation – interleukin 32. Interesting enough, but not really my bag.
The third abstract, I thought, was potentially important. The authors, van Dongen et al., took about 100 patients with undifferentiated arthritis (i.e. early inflammatory arthritis, but not yet clearly rheumatoid or some other kind) and treated them with either methotrexate (MTX) or placebo. They found that the MTX-treated patients had less joint damage and generally progressed more slowly or even remitted. However the interesting effect was that there was no difference in the results when patients were negative for anti-CCP antibodies (these are now known to be fairly well associated with RA and with the risk of more joint damage), but that in patients with anti-CCP, the patients treated with placebo had more joint damage and remitted less frequency compared to those treated with MTX. This is a nice result as it emphasizes the importance of anti-CCP in predicting not only joint damage in RA, but also joint damage in arthritides that are not yet clearly RA. Anti-CCP+ patients appear to benefit from aggressive, early treatment with disease modifying anti-rheumatic drugs (DMARDs) like MTX regardless of whether or not they have clear RA.
The fourth abstract, I thought, was even more interesting. As part of a larger randomized trial of various methods of treating RA, Van Der Kooij, et al. took 120 patients and treated them early and aggressively with MTX and infliximab (IFX – the brand name is Remicaide). If possible, they then tapered first IFX and then MTX over the next 2-3 years. They actually managed to taper 18/120 patients entirely off both drugs. This is impressive because we don’t have cures for RA! When we put patients on DMARDs, we expect them to stay on them for life. But these guys appear to have put 10% of their subjects into remission using this regimen, such that they eventually required no medications at all! That suggests that we might actually be getting to the point where we can talk about ‘curing’ some patients with early RA.
The last abstract was a study of adalimumab (brand name Humira) in juvenile inflammatory arthritis (inflammatory joint diseases are not the same as those in adults). The upshot was that it appeared to work pretty well. I have some reservations about the study design, but I’ll have to wait to read the paper. But it appears clear that kids respond pretty well to this drug.
A nice session in general.